A. HEALTH PROMOTION AND DISEASE PREVENTION
1. The answer is b.
Secondary prevention is the prevention of promotion by smoking cessation and implementation of appropriate screening measures. Primary prevention is the avoidance of exposure to carcinogens. Tertiary prevention consists of arresting, removing, or reversing a premalignant lesion to prevent recurrence or progression to cancer. CNPP, Page 112.
2. The answer is a.
Using barrier contraceptives and practicing safe sex are primary preventive strategies. Obtaining a Pap test at appropriate intervals and HPV testing are secondary prevention and screening methods. Exercise is not a known risk factor for cervical cancer. CNPP, Page 1401.
3. The answer is b.
The synergistic use of both alcohol and tobacco has long been implicated in the etiology of oral cavity malignancies. Approximately 75% of patients with oral cancer drink alcohol, and 90% of patients have a history of tobacco use. Poor oral hygiene and mechanical irritation have also been connected to the development of oral cavity tumors. HPV has been implicated as a causative agent in a subset of oral squamous cancers. CNPP, Pages 1578–1580.
4. The answer is c.
Health-protective lifestyle behaviors (primary prevention) consists of actions taken by people to protect, promote, or maintain their health. CNPP, Page 83.
5. The answer is b.
Reducing UVR exposure and using sunscreens are primary methods of preventions for skin cancer. The other methods are secondary prevention. CNPP, Pages 1682–1683.
6. The answer is d.
There is a 25% increase in lung cancer in women married to a smoker. Environmental tobacco smoke is estimated to lead to 3,000 deaths per year. Secondhand smoke poses an elevated risk of lung cancer for both smokers and never smokers. CNPP, Page 1682.
7. The answer is a.
African American women of lower socioeconomic status obtain fewer mammograms, experience premature deaths, and have a lower survival rate. Research has shown that African American women are more commonly diagnosed with triple-negative breast cancer but does not necessarily relate to SES. CNPP, Pages 1281–1287.
8. The answer is b.
Although education regarding cervical cancer is a primary prevention strategy, the use of Pap test screening is a secondary method of cancer prevention. A, C, and D are measures of primary cancer prevention. CNPP, Pages 88, 1401.
9. The answer is a.
Exercise plays a role in primary prevention for colon, breast, and endometrial cancer. Weaker evidence suggests increased exercise may be protective against prostate, kidney, and lung in nonsmokers and ovarian cancer. CNPP, Page 59.
10. The answer is d.
Moderate to heavy alcohol use has been linked to cancers of the breast, colorectal, esophagus, and liver. No evidence of alcohol use and risk is evident for prostate, renal, or ovarian cancer. CNPP, Page 61.
11. The answer is c.
A healthy balanced diet is the best source of nourishment along with physical activity. Ms. Jones should limit, not increase, the consumption of energy-dense foods, which are processed foods with sugar and fat. High-dose supplements can affect the risk of different cancers. Energy from fat should be limited from 20%–35%. Drinks with a high sugar content should be avoided. CNPP, Pages 58–60.
12. The answer is c.
The two most important factors that appear to have a protective effect against the development of endometrial cancer are oral contraceptives and cigarette smoking because they reduce the estrogenic stimulation on the endometrium. However, risks of developing lung cancer far outweigh protection against endometrial cancer. Pregnancy and weight management also reduces the risk of endometrial cancer. CNPP, Page 1519.
13. The answer is c.
The most successful approaches are increasing excise taxes on tobacco products, local cessation and abstinence programs, and smoke-free laws. Counseling and behavior techniques are successful if used as an adjunct to medical management. Financial incentives by employers are leading to an increase in smoking cessation along with phone and web-based support groups. CNPP, Pages 86, 1686.
14. The answer is c.
The Breast Cancer Prevention Trial tested tamoxifen as a chemopreventive agent in a randomized double-blind trial. The STAR trial compared tamoxifen and raloxifene in reducing the risk of invasive breast cancer. Both drugs were equally effective. CNPP, Page 88.
15. The answer is d.
Additional research is essential before any conclusions can be drawn about the dangers and efficacy of e-cigarettes. CNPP, Pages 62, 86.
16. The answer is a.
There is compelling evidence that obesity is associated with colon, endometrial, esophageal, renal, pancreatic, and postmenopausal breast cancer. There is probable or suggestive evidence of obesity and gallbladder, hepatocellular, ovarian, and thyroid cancers. CNPP, Page 58.
17. The answer is c.
Vaccines have been developed to prevent hepatitis B, a major cause of liver cancer, and for HPV types 16 and 18, which are associated with cervical, anal, and some head and neck cancers. CNPP, Pages 97–98.
18. The answer is c.
Attributable risk is the amount of disease within the population that could be prevented by alteration of a risk factor. Absolute risk measures the occurrence of cancer in the general population, not a high-risk population. Relative risk compares the incidence or deaths among those with a particular risk factor and those without the risk factor. Proportional risk does not implicate which disease an individual will develop. CNPP, Pages 116–117.
19. The answer is a.
Chemoprevention is the use of natural or synthetic agents to interrupt the carcinogenic process. Chemoprevention refers to compounds manufactured in pills, but also capsules and liquid form. Food components ingested as part of a regular diet are not considered chemopreventive agents, however, chemopreventive agents are often derived from food compounds. CNPP, Page 87.
20. The answer is c.
A black male with a family history of prostate cancer is at high risk for prostate cancer. Chemoprevention trials target high-risk individuals with a personal or family history of the disease. Unlike population-based lifestyle interventions, the use of chemopreventive agents can be recommended only for individuals and subpopulations known to be at increased risk for developing a malignancy, to justify their exposure to potential expected or unexpected adverse events. Although the female has dense breasts and is at moderate risk for breast cancer, she should discuss with her doctor the benefits of adding MRI screening to her yearly mammogram. CNPP, Page 87.
21. The answer is a.
She should have a thorough cancer risk assessment and genetic counseling, so she will have the necessary facts about her risk, the alternatives for dealing with her risk, and consideration of the options available to her. Women at high risk may elect to take medicine to suppress ovulation or consider prophylactic oophorectomy at the completion of childbearing. CNPP, Pages 146–149, 1799.
22. The answer is a.
For women at high-risk of hereditary breast and ovarian cancer (HBOC), risk-reducing bilateral mastectomy (RRBM)—the removal of both breasts before a breast cancer is detected—lowers breast cancer risk by 90%. CNPP, Page 152.
23. The answer is a.
The American Cancer Society currently recommends that all who are 21 years of age or older should have annual Pap tests every 3 years using conventional or liquid-based Pap test. CNPP, Pages 124, 1404.
24. The answer is c.
Colonoscopy with removal of polyps is recommended beginning at ages 20–25, repeating every 1–2 years. Evidence does not support screening for gastric, duodenal, and small bowel cancer in Lynch syndrome. Selected individuals may be advised to have upper GI endoscopy between 30–35 years of age every 3–5 years. CNPP, Pages 123, 1433.
25. The answer is b.
Research has shown that men who took finasteride as part of the Prostate Cancer Prevention Trial (PCPT) had a 25% lower incidence of prostate cancer. The selenium and vitamin E cancer prevention trial (SELECT) was stopped because there was a higher incidence of prostate cancer in men taking vitamin E and increased incidence of diabetes in men taking selenium. CNPP, Pages 88, 96.
26. The answer is a.
Modifying sexual behavior, thereby limiting a woman’s exposure to oncogenic human papillomavirus, will prevent cervical cancer. This includes barrier contraceptives and limiting sexual partners. Oral contraceptives, annual Pap smear, or HPV testing are not risk-reducing behaviors for prevention of cervical cancer. CNPP, Page 1401.